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i <br /> BUSINESS CERTIFICATE# 91" — <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of <br /> Business Name/DBA: q� y� Corporation Name: /d.510 �Ti/irs9D�lI�_ -a is conducted at <br /> Business Location: (0 D (L 1 L o Z / f TI JL2 kt�,-2, !- <br /> Business Mailing Address: <br /> Business Type: > ag tJ +�p1`P_ _C_ Business Telephone: <br /> Home Phone: c5W_1i/j7_ Email Address: /k Aaln4,f <br /> by the following named persons: <br /> w Name Owner Residence 7 <br /> Icerci under the penalties perj y that , to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> to as equired, rid r law <br /> g lure authorize age t **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will he subject to license suspension or revocation. This <br /> request is made under the authority of Massachusetts General Law, Chapter,62C,Section 49A. <br /> r' The Commonwealth of Massachusetts <br /> B'ARNSTABLE ss n n DATE <br /> 2 <br /> Personally appeared before me the above-named _aS ?. 0 and made oath that the foregoing statement <br /> is'iFue. <br /> A c ' tcate issued in accorda ith t 's seci a shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four y rs th rcarter <br /> so long s b ines be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> i <br /> • l(thin w�^t <br /> i Notary Public <br /> SEAL VICKI ANN GOVONI <br /> jcow situ <br /> MY Cam balan Eq*p <br /> AN I&=0 <br /> i <br />